Changing our perception of pain – Richard Asinof

by Richard Asinof, ConvergenceRI

Photo: Dr. Frederike Petzschner, Ph.D., the developer of a new app, SOMA

Managing pain is perhaps the ultimate human conundrum, because the emotions and feelings attached to pain are intimately connected to who we are and how we engage, connect with and love one another.

As a nation, in recent years, we have seen ourselves turn inside out to cope with the daily anxiety of living and surviving in a disrupted, over-stressed, climate-threatened world. We have witnessed the rise of the destructive politics of fascism and nihilism.

Our life expectancy rates in the United States during the last two decades have continued to drop precipitously, linked directly to the ongoing overdose epidemic – and, more recently, to the onslaught of COVID. Both have pain as a symptom.

Yet our ability to manage pain, despite the interventions by the pharmaceutical industry and the advances in medicine, still remain an imprecise science at best, often relying on inexact measurements such as physicians and nurses asking patients about their pain on a scale of one to 10.

Recent neuroscience researchers have linked the ways that pain can change the brain circuits that are involved in learning and memory.

The question now being posed by some neuroscientists is this: “Can we rethink our understanding of pain as a form of ‘learned behavior’ that the brain may be able to unlearn?”

On Wednesday, April 12, from 4-5 p.m., the Carney Institute for Brain Sciences will host a virtual Carney Conversation: “Pain and Perception,” featuring Dr. Ziya Gokaslan, MD, chair of the Department of Neurosurgery at the Warrens Alpert Medical School, and Dr. Frederike Petzschner, Ph.D., director of the Carney Brainstorm Program, tasked with accelerating the translation of computational brain Science to clinical applications and commercialization.

The focus of the conversation will be to talk about a new scientific approach to pain management, recently launched by neuroscience researchers at Carney Institute for Brain Sciences at Brown University. The interactive, smartphone app is called “SOMA,” which seeks to change the playing field when it comes to pain management, human perception, and mental health. [See link to App below.]

The goal of the new app is to help “people with acute and chronic pain monitor and track patterns in their mood, pain and daily activities,” identifying which activities may affect their pain, in positive or negative ways, according to a recent news release issued by the Carney Institute.

Then, using data collected from the free app, the Carney neuroscience researchers will, in the future, work to develop personalized treatments that can be delivered through the app and that will be tested in clinical trials, according to a recent news release.

“Chronic pain persists well beyond an injury or illness [emphasis added],” explained the researchers behind the SOMA platform, describing the rationale for the approach in the news release. “It may last a lifetime and be resistant to over-the-counter medications. It’s also among the most common conditions in the U.S., with one in five adults reporting pain on most days or every day, in 2022.”

The explanation continued: “New research suggests that chronic pain may be the result of changes in brain circuits that are involved in learning and memory. Yet, most treatments for pain still focus almost exclusively on the periphery and not the brain.”

ConvergenceRI had the opportunity to interview Dr. Frederike Petzschner, Ph.D., one of the principal developers about the new app — both in a recent Zoom conversation, and in response to written questions.

ConvergenceRI: Who chose the name “SOMA” for the app? Were they aware of the literary reference to Huxley’s “Brave New World?”
PETZSCHNER: I chose SOMA. [I went to a humanistic school and my first foreign language was Latin.] The term SOMA stems from the Greek word σῶμα[ [meaning body, entire person], signifying that it takes a holistic approach to pain. It also stands for the cell body (e.g. of neurons) so from the smallest part to the whole body.

We found out about the link to Brave New World later, but [Huxley’s] inspiration was certainly also the Greek word.

ConvergenceRI: Could you tell me a little bit more about your thinking on the name?
PETZSCHNER: “Soma” is a Greek word that stands for the whole body.

For me, “soma” has always meant the whole body, the Greek meaning of it. And, “soma” is also the nucleus of a cell, including the neuron. So, a cell’s body of a neuron, the center of a cell’s body, is called “soma.”

As a neuroscientist, I have two associations. One is that it stands for the whole body, a holistic approach. The second one is that it stands for the grain of a neuron, and the idea was that we try to take a holistic approach to pain, where we focus on the whole body, including the brain. And, that’s where the name, “soma,” came from.

ConvergenceRI: How is information provided by “participants” using the app secured? Will that information be shared with pharmaceutical firms, or with health insurers?
PETZSCHNER: Information will not be shared with pharmaceutical firms or with health insurers. We implement technical and organizational measures in an effort to protect data from loss, theft, misuse and unauthorized access, disclosure, alteration and destruction, taking into account the nature of the data that we process and risks associated with special categories of data we collect [e.g., information about health)]

These measures include pseudonymization and tokenization of certain categories and encryption of data in transit via SSL and in rest via block storage level encryption.
Currently, SOMA App data is stored on password and multifactor authentication protected Brown University servers. These Brown University servers are located on a separate network requiring the use of VPN to access them.

ConvergenceRI: How does the brain differentiate between acute pain and chronic pain?
PETZSCHNER: Any pain is experienced happens at the level of the brain. This experience of pain is represented in a quite distributed fashion in the brain.

Interestingly, there is less overlap than one would expect between the networks representing acute and chronic pain, and there are substantial plastic changes in the brain associated with the transition from acute to chronic pain.

ConvergenceRI: If a question were to be added to the pain scale index, based on the results from SOMA, what would it be?
PETZSCHNER: Good question. Hard to say.

ConvergenceRI: In a recent interview with the director of a community recovery agency in Rhode Island, she described the key strategy in all recovery efforts to substance use disorders as “connectedness.” How would “SOMA” seek to improve a person’s sense of connectedness as a therapeutic approach?
PETZSCHNER: SOMA allows people to track their pain progression and show their individual trajectories to their family, friends or doctors. We are only starting to build a community around SOMA on Facebook and other social media platforms.

ConvergenceRI: How does SOMA fit in with the concept of precision medicine?
PETZSCHNER: The current version of SOMA basically does tracking. So, it does not offer a therapy yet. But the idea of precision medicine is to be tailoring medication or treatment more to the individual needs.

And, acknowledging the fact that we are all very different, and we have very different needs. And, often times, we have the tendency to treat everybody with broad strokes. Even medication, if you think about drug dosages, they are usually tested on male subjects. [As a result], females often tend to get a dosage that was actually meant for larger bodies, and that is a problem in medicine.

We hope to develop targeted interventions that become part of SOMA in the future, where we offer treatments that are very individually tailored to a patient.

For instance, some people do mindfulness in order to work on their pain. But, mindfulness may be a good idea when pain levels are low, but not such a good idea when pain levels are very high. So, by looking at how you are feeling at a particular moment, different treatments may be offered, depending on your actual pain levels and distress you are experiencing.

We are moving toward that; that is something we are trying to build, yes.

ConvergenceRI: Is there a gender gap when it comes to understanding and treating chronic pain, as suggested by reporter Chelsea Conaboy, in her work, Mother Brain?
PETZSCHNER: The animal literature points to differences in pain processing pathways in males and females, but so far this has not resulted in different treatment pathways in humans. We will be able to see and analyze these differences and hopefully be able to tailor the interventions we are currently working on to an individual’s needs.

ConvergenceRI: What are the metrics for measuring the successful health outcomes of “SOMA” in its application?
PETZSCHNER: SOMA is currently a pain-monitoring app, not a treatment app [though we are working on adding this functionality in the future]. As such, it allows users to independently assess their recovery curves and success of new treatments they may start via the monitoring

ConvergenceRI: Are there specific clinical collaborations underway at Brown regarding the utilization of SOMA, such as with Brown’s mindfulness program, or with the School of Public Health’s efforts around substance use interventions?
PETZSCHNER: Yes, we have started collaborations with different physicians at Lifespan, who are interested in using the app with their patients. And, we have been in touch with the Department of Health in Rhode Island and the Arrigan Center about the development of the app, though there is no official collaboration yet.

ConvergenceRI: Beyond the ongoing collaboration with Lifespan physicians, are you planning to expand that?
PETZSCHNER: Yes. We are working with Dr. Linda Carpenter [Deputy Director of the Butler Hospital COBRE Center of Neuromodulation]. We are planning one project where we might run a study together involving [neurostimulation] treatments for depression, which is highly [associated] with chronic pain.

One thing that we would like to do with them is to look at the effects of [neurostimulation] treatment on chronic pain, because we are looking at both mood and pain, with the app.

ConvergenceRI: How does the app interact with patients, for instance, who are post surgery, and have a great amount of chronic pain from their condition, for which they have a regular dose of prescribed painkillers?
PETZSCHNER: At the moment, we can track, on a daily basis, if they  are taking a medication. The app doesn’t check dosage; it only checks whether you took a medication or not. The same is true for treatment. Every day [on the app], there is an evening [reporting] routine, which basically asks: which medications did you take? And, did you receive any treatments today? Treatments could be everything from massage therapy or psychotherapy to “I had a surgery today.”

We can then display how the pain has evolved after each of these treatments. You can see how these treatments and medication are affecting your pain, not only in the short term, because when we take something, we realize that there is relief right away, that it is very straightforward.

But, with many treatments and medications, it is actually true that it takes a while for them to show an effect on pain. And, we are very bad at tracking things that have a delayed effects on us.

So, what the app is helping with is to see what the prolonged effects of treatments and medications are on our pain levels.

ConvergenceRI: When you do physical therapy, the odds are that you will increase the amount of pain that you have immediately, because you are actually pushing your muscles to go beyond where they are. Perhaps that pain could be considered a “good” thing if you are stretching out your calves, for instance, to gain greater mobility in your legs. Does the app make that differentiation between – I dislike the phrasing – but “good” pain versus “bad” pain?
PETZSCHNER: Yes, I think that is exactly right. Yesterday, I had a Sports massage, because I injured my shoulder, and I was having a “good pain.” [laughter]

Often times, the way we would observe what is pain is that it is increasing in the short term, but in the long run, it is going down. Usually, we do not see these curves by ourselves; we don’t see the dynamics. It is exactly what we are trying to help with, by visualizing how pain is evolving over days and weeks after certain interventions.

ConvergenceRI: What questions haven’t I asked, should I have asked, that you would like to address?
PETZSCHNER: SOMA is pretty unique: It is for free and funded by a university to have a positive impact on people’s lives and improve our understanding of acute and chronic pain.

I want to emphasize that I am very grateful that we could do this and that Brown has been supporting us so much. This has all happened in-house. We also had support from design students at RISD.

Our goal was to build a platform directly that patients could use and find useful. We had interviews with patients from the start, asking about what features they would like. Because I wanted to build something that would be in the hands of patients and, at the same, I wanted to build something that can be used as a platform for scientists, to acquire the types of data that can teach us much more about pain.

It’s interesting. Pain has been studied for so long, and yet we still don’t understand or realize the dynamics and factors that are influencing pain, because it is often not tracked. When you go to the doctor, you have an assessment of pain done, and then you might have another assessment six weeks later. But all the important dynamics in between are lost.

And so, our goal in building this app is to teach us a lot more about pain in the future. It’s been great to see how both clinicians and clinical institutes but also patients have been responding so far. We are very excited.

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To read more articles in RINewsToday by Richard Asinof, go to: https://rinewstoday.com/richard-asinof/

Richard Asinof is the founder and editor of ConvergenceRI, an online subscription newsletter offering news and analysis at the convergence of health, science, technology and innovation in Rhode Island.